For a long time, non-operative treatment has been used for clavicle fractures, which are extremely common in daily life. Although non-operative treatment has the advantages of less trauma and simpler operation, patients suffer a lot of pain and a long course of disease, and the reset is inaccurate and easily re-displaced, and long-term fixation has a great impact on the function of the shoulder joint. With the rapid development of modern transportation and manufacturing industries, high-energy trauma such as car accident injury often leads to crushed and severely displaced fractures at the intersection of the forward and backward curvature of the clavicle in a “~”-shaped bend above the thorax. These fractures are characterized by severe soft tissue damage, self-exfoliation of the periosteum, and loss of blood supply and insertion of fragmented bone into the soft tissue. In a recent multicenter randomized controlled study of 132 completely displaced midclavicular fractures at eight Canadian medical centers, data on shoulder scores, radiographs, patient satisfaction, shoulder range of motion and appearance, and complications were compared between the two groups of patients treated with surgical plate internal fixation and conservative treatment. The results showed that at the 1-year follow-up endpoint, patients in the surgical treatment group had better rates of shoulder function, osteochondral nonunion, and bone nonunion than in the non-surgical treatment. Robinson, on the other hand, proposed a new classification to predict the risk of delayed healing and nonunion of clavicle fractures. He divided clavicle fractures into internal, middle, and external segments, and the multiple middle segment fractures were divided into 2 subtypes: type 2A fractures all had residual bone contact; subtype 2B had no residual bone contact between the main fracture segments and all had significant bone shortening of varying degrees, which were further divided into 2 subtypes: simple or wedge-shaped comminuted fractures (2B1) and isolated or comminuted segmental fractures (2B2). robinson examined Robinson followed up 1000 patients with clavicle fractures treated conservatively and found that 3.2% of type 2B fractures had delayed healing and 5.8% had nonunion, and the follow-up results showed that the poor outcomes of conservative treatment were much higher than those previously reported in the literature. Therefore, based on the above understanding, clinicians currently use surgical internal fixation for unstable complex midclavicular fractures. In our group of 32 patients, all of them had 2B1 and 2B2 clavicle fractures, and intraoperative incision and repositioning could detect fragmented bone pieces of different sizes at the fracture end, some of which were free due to complete peeling of the periosteum, some of which were inserted into the adjacent muscles, and some of which could not be precisely repositioned. In our group, 32 cases treated with surgical incision and reconstruction plate internal fixation achieved the expected purpose of accurate repositioning, secure internal fixation and no adverse complications, and the excellent rate reached 94%. With the in-depth biomechanical and clinical studies of the clavicle, the investigators found that the forces on the clavicle are very complex in the case of mid-clavicle fractures, and the pulling forces of muscles and ligaments as well as the gravitational force generated by the limb have an impact on the fracture displacement. Therefore, surgical internal fixation for clavicle fractures needs to achieve the ultimate goal of restoring the normal anatomical shape of the bone in order to restore the biomechanical dynamic equilibrium of the clavicle. Therefore, the strength and the stress to which the clavicle is subjected after fixation of the internal fixation are two main factors that are relevant to the outcome of surgical treatment. Clinch pin or Clinch pin wire tension band internal fixation is the traditional clavicle fracture incision and internal fixation method, which is less invasive and easy to remove the pin. However, it is difficult to achieve good fixation in every plane of force and motion with the Kirschner pin fixation, and it cannot counteract rotational and axial stresses well, and the fracture end is prone to shear unstable stresses, so the early postoperative functional exercise of the shoulder joint is affected. Secondly, there may be undesirable complications such as loosening of the kyphotic pin, withdrawal of the pin and infection. Ordinary steel plate is thicker difficult to plasticity and irregular clavicle close contact, long-term stress state, easy to cause plate fracture or screw loosening due to stress concentration, resulting in deformed fracture healing or non-healing. The morphological memory alloy annular plate internal fixation has the disadvantages of greater interference with the blood supply of the periosteum, and uneven contact with the clavicle, and cumbersome installation and removal operations. The reconstruction plate is thin and flexible, and can be shaped appropriately according to the shape of the clavicle and fit on the clavicle. When the main fracture line of the clavicle is up and down, the plate should be placed on the upper tension side of the clavicle; while when the main fracture line is anterior and posterior, the plate should be placed on the anterior tension side of the clavicle. Such a plate placed close to the bone surface can play a tension band fixation effect on the clavicle, effectively counteracting the bending stress, axial stress and rotational stress, effectively avoiding the separation of the tension side under the action of external force and facilitating the stress side of the fracture end compression, which is especially suitable for comminuted fractures of the middle clavicle. After the fracture end is firmly fixed, functional exercise of the shoulder joint can be performed early, which reduces the occurrence of various complications caused by poor fracture alignment. Therefore, the author believes that reconstruction plate is recommended for the treatment of middle clavicle comminuted displaced fractures. This is corroborated by the satisfactory outcome of the 32 patients in this group after treatment. The author believes that the good clinical results of surgical internal fixation in this group of 32 patients are inseparable from the focus on the following technical points: 1) Robinson type 2B fractures of the middle clavicle often result in severe local soft tissue damage, fragmentation of the bone into multiple fragmented pieces of varying sizes, and even complete stripping of part of the periosteum and loss of blood supply. Therefore, during surgical debridement and fracture repositioning, care must be taken to protect the fracture end and the blood supply of the fragmented bone, following the principle of extraperiosteal debridement and preserving the muscle and soft tissues attached to the bone mass, and the soft tissues and periosteum of the fragmented bone mass should not be stripped away for a perfect fracture repositioning and the bone mass is completely free and loses its blood supply. Larger fragments can be fixed with screws and fracture ends, and those that cannot be fixed with screws can be drilled and fixed with absorbable wire to the bone stem. Care should be taken to avoid fixation with wire, which can further affect the blood supply and lead to non-union of the fracture. In addition, improved drilling techniques and complete stripping of the periosteum beneath the bone to place a metal blocker for safety are not advocated.2) Robinson type 2B fractures of the middle clavicle are complex unstable fractures with high stress and shear forces at the fracture end. A reconstructive plate of appropriate length is selected to ensure that there are three or more fixation screws on both sides of the fracture line to eliminate stress and shear forces at the fracture end, and the screws must be fixed double cortically to prevent screw extraction. One patient in this group had two screws adjacent to the fracture end that were short and did not pass through the contralateral cortex due to the intraoperative care. The possibility of plate fracture can be reduced. The reconstructive plate should be placed on the upper or anterior tension side of the clavicle according to the alignment of the main fracture line of the clavicle fracture in order to effectively achieve tension band fixation.4) After the fracture is cut and repositioned, all the small fracture fragments should be implanted back to the fracture site. In our group of 32 cases, there was no bone defect in any of the 32 cases of middle clavicle Robinson type 2B fractures after resetting, so no intraoperative bone graft was performed and the bone healed well after surgery. However, the authors agree with the literature that if a bone defect at the fracture end remains after intraoperative fracture reduction, intraoperative bone grafting should be performed in one stage to avoid non-union of the fracture. 5) The duration and intensity of postoperative shoulder functional exercises should be gradual and performed under the guidance of follow-up visits, and excessive shoulder abduction and weight bearing should be avoided until the fracture heals. The clinical efficacy of the surgical treatment of the 32 cases of Robinson type 2B fracture of the middle clavicle in our group is satisfactory, which indicates that the surgery can effectively restore the anatomical form of the comminuted clavicle fracture belonging to the intra-articular fracture of the shoulder, and create the conditions for fracture healing after assisting the strong reconstruction plate internal fixation, and enable the functional exercise of the shoulder joint as early as possible after the surgery.